Head injury protocols in Football.

[Buzzo]

An interesting discussion (I know) was threatening to break out in the Totenham thread about this.

I see there has been some comment today in light of the absurd decision to send Jan Vertonghen back onto the pitch last night. If the protocols were followed then they need changed. Temporary subs to enable a full independent HIA to take place would be the first thing that is needed.

I have a slightly vested interest here as my mates Dad is an ex pro (70's) recently diagnosed with dementia.

Tottenham 0-1 Ajax: Jan Vertonghen injury leads to 'temporary concussion substitutions' calls

Football should introduce "temporary concussion substitutions" says a brain injury charity in the wake of a head injury suffered by Jan Vertonghen.

The Tottenham defender was treated for five minutes on the pitch and tried to play on but was led off after appearing unwell during a 1-0 Champions League semi-final first-leg defeat by Ajax.

Headway says a "reliable diagnosis" cannot be made on the pitch because the "pressure is enormous and unfair, particularly in high-stake games such as Champions League semi-finals".

Spokesman Luke Griggs told BBC Sport: "It is hugely disappointing that we are once again talking about concussion rather than the game itself.

"Concussion is notoriously difficult to diagnose. The symptoms may be hidden and require the individual to be honest about how they're feeling, while they can also be delayed in their presentation.

"Assessing a player for three minutes - or even five, as was the case with Jan Vertonghen - does not allow for medical staff to make a reliable diagnosis, particularly when this is conducted on the pitch under the gaze of tens of thousands of fans eager for the game to resume."

Tottenham 0-1 Ajax: Pochettino not involved in Vertonghen injury decision
Headway has also called for an "urgent review" into concussion protocols.

"We believe the time has come for football to introduce temporary concussion substitutions that would allow for longer off-pitch assessments to be conducted," added Griggs.

"In addition, independent doctors with expertise in concussion and head injuries should make the ultimate decision as to whether or not a player is fit to continue.

"Not every head injury will result in a concussion. But allowing players to continue while showing clear signs of discomfort following a head injury is contrary to the 'if in doubt, sit it out' principle at the heart of all effective concussion protocols."

Spurs boss Mauricio Pochettino said he believed medical staff followed the correct protocols before allowing 32-year-old Belgian international Vertonghen back on the pitch.

No ambulances were called to the stadium and Vertonghen was later seen walking freely through the media zone after the match.

"I wasn't involved. It was the doctor's decision," said Pochettino immediately after the game. "The rules and the protocols are there. Our medical staff followed the protocol.

"He's OK. We hope it is not a big issue. He walked away from the stadium. We know we have to keep watching and monitoring him because it was a big knock."

https://www.bbc.co.uk/sport/football/48116929

[Buzzo]

Previously mentioned discussion with inhouse Devils Advocate, Kenneth.

An independent doctor is not going to tell someone to get back on the pitch if they say they need to come off, have a headache, say they feel dizzy etc. It would get abused.

It might initially, but it would work itself out - and the protocol existing is more important than it initially being abused. Player wellfare has become an actual priority in Rugby over the last 3-4 years as opposed to it just being paid lip service. I have seen star players leave the field after 15 mins on HIA's, and players not feature again for 6 months plus due to HIA protocols. Obviously there are more collisions in Rugby, but the protocols are now taken seriously.

It would require rule changes, but all of them are simple and easily doable. Bare in mind this was successful in Rugby, a sport where there has been scandal around fake injuries (fake blood capsules to get a replacement).

The knock on effects in both sports are huge, and the repercussions on players will hit them in later life one of my mates Dad is an ex-pro who has been diagnosed with dementia, and the rate of ex-pros with Dementia is worryingly high.

Something will have to change n football, last night and the embarassing response from Pochettino tell you all you need to know (he claims the medics did not make a mistake and return to field protocols were followed, if that is true then it highlights the extent of the issue).

The protocols in Rugby are as follows.

When there is a suspected incident of head impact by a player or players, this should be identified by match officials on the field, team doctors or independent match-day doctors who have access to video replays. If the independent match-day doctor decides an incident may have occurred, the player(s) involved must be removed, either permanently or for further assessment.

Players displaying obvious on-pitch signs of concussion must be immediately and permanently removed from play, without further assessment.
When not showing clear on-pitch symptoms or signs, players must undergo an off-field assessment consisting of a clinical evaluation by an attending doctor (the team doctor does this or they can delegate to the match-day doctor) who is aided by screening tools and video reviews. Players cannot return before ten minutes for assessment has elapsed. Players taken off for HIA can be replaced, and any replacement can take a kick.

After the match every player entered into the HIA protocol must undergo another evaluation within three hours. This is done using a check of symptoms, memory assessment and balance evaluation – compared with previous player baselines.

At 36-48 hours post-head impact event, the player(s) will be assessed again, going through a symptoms check-list, studying a player’s balance and using a cognitive assessment tool like CogSport or Impact.

Each union and/or competition must appoint trained HIA review processor(s) to look over the process used in every head injury event.

There will be a post-game video review process. Depending on the findings, the reviewer may recommend further education and training for the club or team medical personnel or recommend that the process moves to HIA review.

The HIA review group will formally investigate the incident and make recommendations for: further education and training for the club or team medics; a request to World Rugby’s HIA working group to consider a change to the process, education and/or training; or a referral to the appropriate disciplinary group to consider disciplinary action in line with competition rules.

[Buzzo]

A reminder of how badly wrong football is handling this just now.

Absolute disgrace by everyone concerned. Football needs to have a proper look at HIA protocols and layer wellfare has to come before everything. There should be fines for sending a player back on in that state its embarrassing.

He was absolutely spark out on the pitch blood pouring out of his head. "Clean him up, new kit ask him if he is ok and back on the pitch". Not even sure what the physio was doing with him?

It was so severe he was sick on the pitch his legs went when he went off.

Head knocks clearly need an independent doctor to oversee them. And you should get a free sub to replace HIA's.

[ame]https://twitter.com/MelvinTunde/status/1123315897287041024[/ame]

[ame]https://twitter.com/FIFAWCGoals/status/1123316633651634176[/ame]

[Buzzo]

I think we (Liverpool) played an absolute blinder with HIA's recently with Fabinho. Literally on the pitch for 2 minutes, knocked out, willing to play on, but subbed off. Player welfare front and centre in the decision despite us wasting a sub (and a talented player) in a must win game.

For me a free HIA sub should be allowed in the instance of HIA's not being able to return to the pitch, and a temp usb whilst the HIA takes place. We should have a time on/off system whilst all this takes place (same with VAR).

Not complicated at all.

[labourRed]

Good discussion you're having with yourself Buzzo.

There's not really much to add though.

Football simply needs to educate itself better or moreover its medical staff do. Independent doctors is a concern as that will only cover elite or professional games.

I don't think you need to be a doctor to diagnose a serious head injury, as you said he was spark out with claret all over the place... that to me is a pretty clear indication of a significant enough head injury... Perhaps the referee can adjudicate here as he almost looked like was about to last night.

You can't expect a club employee to tell the manager to withdraw a player in the last ten minutes even if it was clear to casual observers like we were last night that there was no way Vertonghen looked OK to continue. Maybe VAR can be extended to cover this.

[Buzzo]

Good discussion you're having with yourself Buzzo.

There's not really much to add though.

Football simply needs to educate itself better or moreover its medical staff do. Independent doctors is a concern as that will only cover elite or professional games.

I don't think you need to be a doctor to diagnose a serious head injury, as you said he was spark out with claret all over the place... that to me is a pretty clear indication of a significant enough head injury... Perhaps the referee can adjudicate here as he almost looked like was about to last night.

You can't expect a club employee to tell the manager to withdraw a player in the last ten minutes even if it was clear to casual observers like we were last night that there was no way Vertonghen looked OK to continue. Maybe VAR can be extended to cover this.

These are always the most enlightening discussions on here for me


Last nights example was so extreme that it really does highlight how far football has to go. There’s just no way the protocols are sufficient if a guy is getting sent back on the pitch in such a state.

I know what you are saying about the fact that lower leagues will not be able to afford independent doctors, but of the change starts visibly at the top common sense will filter down.

It is only a game. And though the stakes are high, player safety is crucial.

[baitman]

I think we (Liverpool) played an absolute blinder with HIA's recently with Fabinho. Literally on the pitch for 2 minutes, knocked out, willing to play on, but subbed off. Player welfare front and centre in the decision despite us wasting a sub (and a talented player) in a must win game.

For me a free HIA sub should be allowed in the instance of HIA's not being able to return to the pitch, and a temp usb whilst the HIA takes place. We should have a time on/off system whilst all this takes place (same with VAR).

Not complicated at all.

Makes perfect sense to me, im balls deep.

It means teams will need to have a spare sub on the bench just in case they have used all three subs and then later there is a head injury that needs an automatic replacement.

[Cerbie]

Was watching Villa destroy the Hammers yesterday, saw Zanilolo feign a head injury.

Carra said it is happening more and more to break up play, his suggestion was just to play on. When you read this thread and the serious implications of head injuries, I don’t think we should be advocating for that. It is simulation though, so how about using VAR to judge if there was a legitimate (clear and obvious maybe?) contact that warranted the player going down? If not book them for diving.

I’d prefer to see a sin bin for this type of thing though. Maybe 5 mins, or however long a proper head injury assessment would take. Being a man down might be more of a deterrent than a yellow card.

[Norbs]

Players need to be called out for feigning injury. If implying a head injury lead to a 7 day injury lay off they'd curb it. These are ridiculously rich men being arseholes

[vlahka]

Anytime someones on the floor holding their head and they havent moved in 20seconds, they should be taken off for 5min. Watch them suddenly stop cheating.

[Fosterbloke]

Was watching Villa destroy the Hammers yesterday, saw Zanilolo feign a head injury.

Carra said it is happening more and more to break up play, his suggestion was just to play on. When you read this thread and the serious implications of head injuries, I don’t think we should be advocating for that. It is simulation though, so how about using VAR to judge if there was a legitimate (clear and obvious maybe?) contact that warranted the player going down? If not book them for diving.

I’d prefer to see a sin bin for this type of thing though. Maybe 5 mins, or however long a proper head injury assessment would take. Being a man down might be more of a deterrent than a yellow card.

If it's serious enough to warrant stopping the game, then they have to stay off the pitch for 5-10 minutes. Watch them recover quick smart!

[Cerbie]

If it's serious enough to warrant stopping the game, then they have to stay off the pitch for 5-10 minutes. Watch them recover quick smart!

But I suspect it will be more easily addressed via the issuing of a card for simulation rather than changing the rules or adding a new precaution/punishment.

[Fivex]

I’m sure there was a rule brought in that forced potentially concussed players to go off the pitch until the next break in play.. is that still meant to be a thing?

If so then it seems reasonable to force a 5min delay as part of that..

There’s an argument for fairness too; if someone gets potentially concussed then why should the opposition team get a man advantage? So my next line of thought would be to remove both players from the pitch for that period.. But then you can’t take them both off for 5 mins otherwise you’ve got gamesmanship there too, eg keepers being forced off the pitch when the opposition player is faking it.

[Fivex]

Not sure getting VAR to review the incidents would be the best way forward either since the refs apply the rules completely arbitrarily depending on who’s playing.. and these incidents can be quite subjective/unclear at the best of times..

It could also encourage players who are genuinely concussed to get up & continue playing if they’re already on a yellow, since they don’t want to risk getting a bad hand from the likes of Cootes.

Putting on unlimited added time (like now) seems like the best solution from a bad bunch imo

[Scratch]

Make it like rugby, allow the physio to enter the field of play if it is safe; referee can play on until the ball goes out of play or until it enters into proximity of the fallen player.